Imaging Modalities for Evaluation of Intestinal Obstruction

Abstract

It is essential for the colon and rectal surgeon to understand the evaluation and management of patients with both small and large bowel obstructions. Computed tomography is usually the most appropriate and accurate diagnostic imaging modality for most suspected bowel obstructions. Additional commonly used imaging modalities include plain radiographs and contrast imaging/fluoroscopy, while less commonly utilized imaging modalities include ultrasonography and magnetic resonance imaging. Regardless of the imaging modality used, interpretation of imaging should involve a systematic, methodological approach to ensure diagnostic accuracy.

Keywords

bowel obstruction - small bowel obstruction - large bowel obstruction - imaging - computed tomography - abdominal radiography - contrast enema - small bowel follow-through - ultrasound - magnetic resonance imaging

Disclosures

The authors have no relevant financial disclosures.

Publikationsverlauf

Artikel online veröffentlicht:
02. Juni 2021

• References

• 1 Yeo HL, Lee SW. Colorectal emergencies: review and controversies in the management of large bowel obstruction. J Gastrointest Surg 2013; 17 (11) 2007-2012
• 2 Markogiannakis H, Messaris E, Dardamanis D. et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13 (03) 432-437
• 3 Drożdż W, Budzyński P. Change in mechanical bowel obstruction demographic and etiological patterns during the past century: observations from one health care institution. Arch Surg 2012; 147 (02) 175-180
• 4 Parikh JA, Ko CY, Maggard MA, Zingmond DS. What is the rate of small bowel obstruction after colectomy?. Am Surg 2008; 74 (10) 1001-1005
• 5 Aberg H, Påhlman L, Karlbom U. Small-bowel obstruction after restorative proctocolectomy in patients with ulcerative colitis. Int J Colorectal Dis 2007; 22 (06) 637-642
• 6 The ASCRS Textbook of Colon and Rectal Surgery. 3rd ed.. New York, NY: Springer Science+Business Media; 2016
• 7 Eskelinen M, Ikonen J, Lipponen P. Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain. Scand J Gastroenterol 1994; 29 (08) 715-721
• 8 Laméris W, van Randen A, van Es HW. et al; OPTIMA Study Group. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 2009; 338: b2431
• 9 Breum BM, Rud B, Kirkegaard T, Nordentoft T. Accuracy of abdominal auscultation for bowel obstruction. World J Gastroenterol 2015; 21 (34) 10018-10024
• 10 Gore RM, Silvers RI, Thakrar KH. et al. Bowel obstruction. Radiol Clin North Am 2015; 53 (06) 1225-1240
• 11 Paulson EK, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 2015; 275 (02) 332-342
• 12 Suri S, Gupta S, Sudhakar PJ, Venkataramu NK, Sood B, Wig JD. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol 1999; 40 (04) 422-428
• 13 Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology 2015; 275 (03) 651-663
• 14 Thompson WM, Kilani RK, Smith BB. et al. Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter?. AJR Am J Roentgenol 2007; 188 (03) W233-W238
• 15 Mettler Jr FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248 (01) 254-263
• 16 Smith-Bindman R, Lipson J, Marcus R. et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009; 169 (22) 2078-2086
• 17 James B, Kelly B. The abdominal radiograph. Ulster Med J 2013; 82 (03) 179-187
• 18 Musson RE, Bickle I, Vijay RK. Gas patterns on plain abdominal radiographs: a pictorial review. Postgrad Med J 2011; 87 (1026): 274-287
• 19 Maglinte DD, Reyes BL, Harmon BH. et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol 1996; 167 (06) 1451-1455
• 20 Harlow CL, Stears RL, Zeligman BE, Archer PG. Diagnosis of bowel obstruction on plain abdominal radiographs: significance of air-fluid levels at different heights in the same loop of bowel. AJR Am J Roentgenol 1993; 161 (02) 291-295
• 21 Taourel P, Kessler N, Lesnik A, Pujol J, Morcos L, Bruel JM. Helical CT of large bowel obstruction. Abdom Imaging 2003; 28 (02) 267-275
• 22 Ramanathan S, Ojili V, Vassa R, Nagar A. Large bowel obstruction in the emergency department: imaging spectrum of common and uncommon causes. J Clin Imaging Sci 2017; 7: 15
• 23 Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg 2012; 25 (04) 236-244
• 24 Swenson BR, Kwaan MR, Burkart NE. et al. Colonic volvulus: presentation and management in metropolitan Minnesota, United States. Dis Colon Rectum 2012; 55 (04) 444-449
• 25 Wang JH, Furlan A, Kaya D, Goshima S, Tublin M, Bae KT. Pneumatosis intestinalis versus pseudo-pneumatosis: review of CT findings and differentiation. Insights Imaging 2011; 2 (01) 85-92
• 26 Torres US, Fortes CDFM, Salvadori PS, Tiferes DA, Ippolito GD. Pneumatosis from esophagus to rectum: a comprehensive review focusing on clinico-radiological differentiation between benign and life-threatening causes. Semin Ultrasound CT MR 2018; 39 (02) 167-182
• 27 Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 1978; 187 (03) 281-287
• 28 Frager D, Rovno HD, Baer JW, Bashist B, Friedman M. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging 1998; 23 (02) 141-146
• 29 Godfrey EM, Addley HC, Shaw AS. The use of computed tomography in the detection and characterisation of large bowel obstruction. N Z Med J 2009; 122 (1305): 57-73
• 30 Pongpornsup S, Tarachat K, Srisajjakul S. Accuracy of 64 sliced multi-detector computed tomography in diagnosis of small bowel obstruction. J Med Assoc Thai 2009; 92 (12) 1651-1661
• 31 Gans SL, Stoker J, Boermeester MA. Plain abdominal radiography in acute abdominal pain; past, present, and future. Int J Gen Med 2012; 5: 525-533
• 32 Ros PR, Huprich JE. ACR appropriateness criteria on suspected small-bowel obstruction. J Am Coll Radiol 2006; 3 (11) 838-841
• 33 Hong SS, Kim AY, Byun JH. et al. MDCT of small-bowel disease: value of 3D imaging. AJR Am J Roentgenol 2006; 187 (05) 1212-1221
• 34 Hodel J, Zins M, Desmottes L. et al. Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations. Abdom Imaging 2009; 34 (01) 35-41
• 35 ACR Manual on Contrast Media: 2020 Version. Available at: https://www.acr.org/~/media/acr/files/clinical-resources/contrast_media.pdf 2020
• 36 Atri M, McGregor C, McInnes M. et al. Multidetector helical CT in the evaluation of acute small bowel obstruction: comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT. Eur J Radiol 2009; 71 (01) 135-140
• 37 Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed.. Philadelphia, PA: Elsevier/Saunders; 2015
• 38 Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics 2009; 29 (02) 423-439
• 39 Ha HK, Kim JS, Lee MS. et al. Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 1997; 204 (02) 507-512
• 40 Khurana B, Ledbetter S, McTavish J, Wiesner W, Ros PR. Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 2002; 178 (05) 1139-1144
• 41 Colon MJ, Telem DA, Wong D, Divino CM. The relevance of transition zones on computed tomography in the management of small bowel obstruction. Surgery 2010; 147 (03) 373-377
• 42 Mayo-Smith WW, Wittenberg J, Bennett GL, Gervais DA, Gazelle GS, Mueller PR. The CT small bowel faeces sign: description and clinical significance. Clin Radiol 1995; 50 (11) 765-767
• 43 Catalano O. The faeces sign. A CT finding in small-bowel obstruction. Radiologe 1997; 37 (05) 417-419
• 44 Khaled W, Millet I, Corno L. et al. Clinical relevance of the feces sign in small-bowel obstruction due to adhesions depends on its location. AJR Am J Roentgenol 2018; 210 (01) 78-84
• 45 Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 2004; 183 (05) 1361-1366
• 46 Beattie GC, Peters RT, Guy S, Mendelson RM. Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg 2007; 77 (03) 160-165
• 47 Schwartz S, Nadelhaft J. Simulation of colonic obstruction at the splenic flexure by pancreatitis: roentgen features. Am J Roentgenol Radium Ther Nucl Med 1957; 78 (04) 607-616
• 48 Zaman S, Chapman W, Mohammed I, Gill K, Ward ST. Patients with computed tomography-proven acute diverticulitis require follow-up to exclude colorectal cancer. Intest Res 2017; 15 (02) 195-202
• 49 Hayakawa K, Tanikake M, Yoshida S. et al. Radiological diagnosis of large-bowel obstruction: nonneoplastic etiology. Jpn J Radiol 2012; 30 (07) 541-552
• 50 Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit AM. CT findings of sigmoid volvulus. AJR Am J Roentgenol 2010; 194 (01) 136-143
• 51 Santillan CS. Computed tomography of small bowel obstruction. Radiol Clin North Am 2013; 51 (01) 17-27
• 52 Matsushima K, Inaba K, Dollbaum R. et al. High-density free fluid on computed tomography: a predictor of surgical intervention in patients with adhesive small bowel obstruction. J Gastrointest Surg 2016; 20 (11) 1861-1866
• 53 Sheedy SP, Earnest IV F, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 2006; 241 (03) 729-736
• 54 Kinoshita H, Shinozaki M, Tanimura H. et al. Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature. Arch Surg 2001; 136 (12) 1410-1414
• 55 Jacob SE, Lee SH, Hill J. The demise of the instant/unprepared contrast enema in large bowel obstruction. Colorectal Dis 2008; 10 (07) 729-731
• 56 Chapman AH, McNamara M, Porter G. The acute contrast enema in suspected large bowel obstruction: value and technique. Clin Radiol 1992; 46 (04) 273-278
• 57 Lips LM, Cremers PT, Pickhardt PJ. et al. Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography. Radiology 2015; 275 (01) 127-135
• 58 de Gregorio MA, Mainar A, Rodriguez J. et al. Colon stenting: a review. Semin Intervent Radiol 2004; 21 (03) 205-216
• 59 Emergency General Surgery: A Practical Approach. New York, NY: Springer Berlin Heidelberg; 2018
• 60 Kurer MA, Davey C, Chintapatla S. Intestinal obstruction from inspissated barium (Barolith): a systematic review of all cases from 1950 to 2006. Colorectal Dis 2008; 10 (05) 431-439
• 61 Bardan E. Gastrointestinal Motility Disorders: A Point-of-Care Clinical Guide. New York, NY: Springer Science+Business Media; 2017
• 62 Koh A, Adiamah A, Chowdhury A, Mohiuddin MK, Bharathan B. Therapeutic role of water-soluble contrast media in adhesive small bowel obstruction: a systematic review and meta-analysis. J Gastrointest Surg 2020; 24 (02) 473-483
• 63 Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg 2007; 94 (04) 404-411
• 64 Burge J, Abbas SM, Roadley G. et al. Randomized controlled trial of Gastrografin in adhesive small bowel obstruction. ANZ J Surg 2005; 75 (08) 672-674
• 65 Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 1994; 115 (04) 433-437
• 66 Gottlieb M, Peksa GD, Pandurangadu AV, Nakitende D, Takhar S, Seethala RR. Utilization of ultrasound for the evaluation of small bowel obstruction: a systematic review and meta-analysis. Am J Emerg Med 2018; 36 (02) 234-242
• 67 Graham A, Carlberg DJ. Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions. Cham, Switzerland: Springer; 2019
• 68 Ogata M, Imai S, Hosotani R, Aoyama H, Hayashi M, Ishikawa T. Abdominal sonography for the diagnosis of large bowel obstruction. Surg Today 1994; 24 (09) 791-794
• 69 Nicolaou S, Kai B, Ho S, Su J, Ahamed K. Imaging of acute small-bowel obstruction. AJR Am J Roentgenol 2005; 185 (04) 1036-1044
• 70 Goudie A. Detection of intraperitoneal free gas by ultrasound. Australas J Ultrasound Med 2013; 16 (02) 56-61
• 71 Fidler J. MR imaging of the small bowel. Radiol Clin North Am 2007; 45 (02) 317-331
• 72 Beall DP, Fortman BJ, Lawler BC, Regan F. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol 2002; 57 (08) 719-724
• 73 Maung AA, Johnson DC, Piper GL. et al; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05, Suppl 4): S362-S369
• 74 Furukawa A, Saotome T, Yamasaki M. et al. Cross-sectional imaging in Crohn disease. Radiographics 2004; 24 (03) 689-702
• 75 Regan F, Beall DP, Bohlman ME, Khazan R, Sufi A, Schaefer DC. Fast MR imaging and the detection of small-bowel obstruction. AJR Am J Roentgenol 1998; 170 (06) 1465-1469
• 76 Rodriguez P, Mendez R, Matute F, Hernandez P, Mendoza JL. Imaging Crohn disease: MR enterography. J Comput Assist Tomogr 2014; 38 (02) 219-227
• 77 Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R. Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology 2004; 233 (02) 338-344
• 78 Jensen MD, Kjeldsen J, Rafaelsen SR, Nathan T. Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn's disease. Scand J Gastroenterol 2011; 46 (12) 1449-1457
• 79 Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175 (03) 621-628
• 80 Jung JW, Kang HR, Kim MH. et al. Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology 2012; 264 (02) 414-422
• 81 Trcka J, Schmidt C, Seitz CS, Bröcker EB, Gross GE, Trautmann A. Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy?. AJR Am J Roentgenol 2008; 190 (03) 666-670
• 82 Lasser EC, Berry CC, Talner LB. et al. Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. N Engl J Med 1987; 317 (14) 845-849
• 83 Toprak O, Cirit M. Risk factors for contrast-induced nephropathy. Kidney Blood Press Res 2006; 29 (02) 84-93
• 84 Elicker BM, Cypel YS, Weinreb JC. IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. AJR Am J Roentgenol 2006; 186 (06) 1651-1658
• 85 Davenport MS, Khalatbari S, Cohan RH, Ellis JH. Contrast medium-induced nephrotoxicity risk assessment in adult inpatients: a comparison of serum creatinine level- and estimated glomerular filtration rate-based screening methods. Radiology 2013; 269 (01) 92-100
• 86 Younathan CM, Kaude JV, Cook MD, Shaw GS, Peterson JC. Dialysis is not indicated immediately after administration of nonionic contrast agents in patients with end-stage renal disease treated by maintenance dialysis. AJR Am J Roentgenol 1994; 163 (04) 969-971
• 87 Grobner T, Prischl FC. Gadolinium and nephrogenic systemic fibrosis. Kidney Int 2007; 72 (03) 260-264
• 88 Webster PJ, Bailey MA, Wilson J, Burke DA. Small bowel obstruction in pregnancy is a complex surgical problem with a high risk of fetal loss. Ann R Coll Surg Engl 2015; 97 (05) 339-344
• 89 Kok RD, de Vries MM, Heerschap A, van den Berg PP. Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: a follow-up study. Magn Reson Imaging 2004; 22 (06) 851-854
• 90 Sabiston DC, Townsend CM. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed.. Philadelphia, PA: Elsevier Saunders; 2012